Maternal anemia: A hidden determinant of complicated labor and adverse neonatal outcomes (A literature review)
DOI:
https://doi.org/10.37800/RM.1.2026.680Keywords:
anemia in pregnancy, iron deficiency, placental dysfunction, perinatal outcomes, hypoxia, hepcidinAbstract
Relevance: Pregnancy is a physiological condition characterized by high metabolic demands, and adequate iron homeostasis is a key determinant of gestational stability. Impaired iron supply leads to the development of anemia, one of the most common pregnancy complications, and is associated with adverse maternal and perinatal outcomes. The epidemiology of anemia during pregnancy is characterized by pronounced regional variability and persistently high prevalence, even in countries with moderate socioeconomic development. The nonlinear increase in iron requirements combined with physiological hemodilution creates conditions for rapid depletion of iron stores, particularly in women with subclinical deficiency. In this context, pregnancy-related anemia should be regarded as a multisystem pathophysiological syndrome requiring a reassessment of diagnostic, monitoring, and correction strategies.
The study aimed to develop a comprehensive systemic view of maternal anemia as a key pathogenic determinant of adverse perinatal outcomes and placental dysfunction.
Materials and Methods: Literature searches were performed in the PubMed, Scopus, and Google Scholar databases for the period 2016–2024 using the following keywords: anemia in pregnancy, iron deficiency, placental dysfunction, perinatal outcomes, hypoxia, and hepcidin. The analysis included systematic reviews, randomized clinical trials, and large cohort studies.
Results: Iron deficiency during pregnancy initiates a trimester-specific pathophysiological cascade characterized by chronic tissue hypoxia, immune and endothelial dysfunction, activation of inflammatory and oxidative pathways, and progressive placental insufficiency. These alterations are associated with fetal growth restriction, preeclampsia, preterm birth, fetal distress, and long-term neurocognitive and metabolic disorders in offspring. A U-shaped relationship between iron status and the risk of adverse outcomes was identified, confirming the “iron paradox” of pregnancy—the pathogenic potential of both iron deficiency and iron overload. Hepcidin-mediated functional iron deficiency plays a central role in the development of treatment-resistant forms of anemia.
Conclusion: Maternal anemia represents a multisystem disorder extending far beyond a purely hematological condition and decisively shaping perinatal outcomes and the health trajectory of future generations. The implementation of early personalized monitoring of iron homeostasis, optimization of screening programs, and the application of modern therapeutic strategies offers realistic opportunities to reduce maternal and perinatal morbidity.
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